Perforation Following Colorectal Endoscopy: What Happens Beyond the Endoscopy Suite?Michael S Tam, MD; Maher A Abbas, MD, FACS, FASCRSIn a retrospective review over 16 years at a single tertiary care institution of 132,259 colorectal endoscopies, 26 patients (0.02%) had a perforation. The rectosigmoid colon was the most common site of perforation (65%). Of the perforations, 38% were recognized at the time of procedure, 31% presented within 24 hours, and 31% presented beyond 24 hours. Operative repair was undertaken in 85% of the patients. Perforation following colorectal endoscopy was uncommon in this study but was associated with significant morbidity and mortality.

Adverse Childhood Experiences and Adult Criminality: How Long Must We Live before We PossessOur Own Lives?James A Reavis, PsyD; Jan Looman, PhD; Kristina A Franco; Briana RojasSubjects (151) from 4 different offender groups (nonsexual child abusers, domestic violence offenders, sexual offenders, and stalkers) referred for treatment at an outpatient clinic in San Diego, CA, after conviction in criminal court, completed the ACE Questionnaire. The offender group reported nearly 4 times as many adverse events in childhood than an adult male normative sample. In addition, convicted sexual offenders and child abusers were more likely to report experiencing sexual abuse in childhood than other offender types.

A Novel Population-Based Health Index for Mental DisorderDavid Cawthorpe, MSc, PhDRandomly selected individuals (685,684 and 45.8% male), with physician-billing visit and cost data from 1994 to 2009 were grouped on the basis of presence or absence of a psychiatric disorder (53% over 16 fiscal years). The median cost of physical (biomedical/somatic) disorders was 2.9 times higher for the group with any International Classification of Diseases psychiatric disorder. This is a novel population health index that holds the potential to directly measure the impact of promotion and prevention programs associated with psychiatric disorders.

Weight-Loss Study in African-American Women: Lessons Learned from Project Take HEED and Future, Technologically Enhanced DirectionsPamala J Murphy, MD; Roger L Williams, MEdBegun in 2005, an 18-month randomized clinical trial, culturally adapted an evidence-based dietary approach and exercise program to fit the female African-American population. The study included 223 African-American women (120 in the experimental group). That group received education and instruction at 24 group sessions and recorded their daily food intake and physical activity. Controls received usual care (referral to a dietitian). After 18 months, the treatment group consisted of 12 women (attrition rate of 87%) who had begun the study low in self-efficacy.

Nutritional Update for Physicians: Plant-Based DietsPhilip J Tuso, MD; Mohamed H Ismail, MD; Benjamin P Ha, MD; Carole Bartolotto, MA, RDPhysicians are becoming more involved in helping their patients adopt healthier lifestyles. Healthy eating may be best achieved with a plant-based diet (which encourages whole, plant-based foods and discourages meats, dairy products, and eggs as well as all refined and processed foods). Research shows that these diets are cost-effective, low-risk interventions that may lower body mass index, blood pressure, HbA1C, and cholesterol levels, and may also reduce the number of medications needed to treat chronic diseases

Understanding the Social Factors That Contribute to Diabetes: A Means to Informing Health Care and Social Policies for the Chronically IllJacqueline Hill, MPH; Marcia Nielsen, PhD, MPH; Michael H Fox, ScDSocial determinants of health are increasingly being recognized for their relationship to the soaring incidence of Type 2 diabetes in the US. Interventions focus on biologic and behavioral factors, such as symptoms, diet, and physical activity. It is equally important to address the influence of physical and social environments on health outcomes: low income, employment insecurity, low educational attainment, and poor living conditions. The Patient Protection and Affordable Care Act of 2010 offers an opportunity to improve data collection and policy development.

Disclosing Medical Mistakes: A Communication Management Plan for PhysiciansSandra Petronio, PhD; Alexia Torke, MD, MS; Gabriel Bosslet, MD, MA; Steven Isenberg, MD; Lucia Wocial, RN, PhD; Paul R Helft, MDThere is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate. This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes: 1) physician preparation, such as talking about the physician's emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include optimal timing, context of disclosure delivery, the content of mistake messages, sequencing, and apology.

Review Articles

A Clinician's Guide to the Diagnosis and Management of Gallbladder VolvulusBrian J Pottorf, MD; Leonardo Alfaro, MD; Harris W Hollis, MDGallbladder volvulus (GV), or torsion of the gallbladder, is an uncommon surgical emergency. This article reviews the world literature related to GV. Lists of typical symptoms and clinical presentations are provided to allow clinicians to establish an accurate preoperative diagnosis. GV is frequently undiagnosed before surgical intervention. When the diagnosis has been established before operative intervention, expeditious laparoscopic cholecystectomy can be performed safely. Delays in diagnosis may mandate open cholecystectomy.

Propofol-Related Infusion Syndrome: Role of Propofol in Medical Complications of Sedated Critical Care PatientsTalha Imam, MDUse of propofol has increased manifold over the last decade, most commonly in intensive care settings, in patients critically ill or injured requiring prolonged sedation. Most of the deaths reported were at propofol levels greater than 4 mg/kg/hour, and many of these for greater than 48 hours. Metabolic acidosis is among the earliest signs and can occur within hours. Adequate carbohydrate intake will prevent the body from switching to fat metabolism.